A Bold New Approach to Treating Back Pain

Peter O’Sullivan, Professor of Musculoskeletal Physiotherapy at Perth’s Curtin University, is one of the world’s most knowledgeable and influential back pain experts, and recently I was lucky to attend one of his rare appearances in London for a three day course where he shared a treatment approach that systematically addressed all the problems I discussed in my last blog.

O’Sullivan explained that overzealous treatment of structural issues often result in even more trauma without addressing the true underlying cause. Injections, surgeries, fusing vertebrae – these treatment options, that should be used for edge cases, are currently massively overprescribed, resulting in patients having invasive and painful procedures that are often unnecessary and ineffective.

Unless a patient is part of the roughly 5% of back pain sufferers for whom structural problems are the source of the pain, O’Sullivan found much more successful results by talking to a patient and thoroughly exploring their background, their lifestyle, their activities and anything else that could have an effect on their back pain.

For example, depression is around 2.3 times more likely to be the cause of back pain than anything we find in an MRI. Stress is also a significant factor in both the tension of the muscles and the sensitivity of the nerves connecting to them, as stress heightens the sensation of all pain in the body.

A patient’s family background, as well, can put them at higher risk of developing back pain, not necessarily for genetic reasons, either. If a patient grew up in a home where a family member had chronic pain, their perception and response to their own pain changes and makes them more at risk of developing a chronic condition themselves.

The list goes on and on: the patient’s work environment, activity level, diet, other medical conditions, how friends or family have dealt with back pain – there’s a lot more to developing an effective treatment plan for a patient than putting them in an MRI machine and attempting to treat the first abnormality that presents itself.

Though patients often desire a purely physical solution to their problem – which is part of what makes MRI scans so seductive – a far larger proportion of their condition is likely to be psychological, and it’s by working from that point backwards that a physician is able to encourage true, lasting physical change and effective pain relief.

O’Sullivan demonstrated his treatment method first hand with a few patients he had invited to the course who suffered from chronic back pain. One had previously been given three epidural injections in the spine which only provided transient relief. After that proved ineffective, they had three of their vertebrae fused together to prevent movement.

After months of rehabilitation (which focused on core stability rather than strengthening the muscles around the spine), the patient was still feeling pain. This was despite injections, surgery and rehab – exhausting all the typical treatments available for chronic back pain.

When they were introduced in the course, this patient was sitting bolt upright in the perfect, 90 degree “good posture” so many people are pushed into. O’Sullivan encouraged them to instead slouch in the chair, and, to the patient’s surprise, they felt much better, and even after sitting for some time, their pain didn’t come back.

O’Sullivan then gradually reintroduced movement to the patient’s spine, starting with bending forward from a seated position, then standing, until eventually they were lifting heavy boxes with a bent back and – amazingly – no pain.

This demonstrated how important movement and muscle activation is to reducing pain and keeping it at bay, and why rest can only go so far before it only starts making it worse. Reducing movement – especially going as far as to fuse vertebrae together – is very rarely the correct course of action.

There was far more I learned in those three days than I could possibly fit into this blog, but the important thing is that people like O’Sullivan are making an impact in the field of physiotherapy and beyond, and will hopefully be able to reverse the growing trend of chronic back pain through a more sympathetic and patient-tailored approach – which is exactly what we believe in at Physio London.

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